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PG CORNER
Year : 2018  |  Volume : 2  |  Issue : 2  |  Page : 160-162

The art of sexual history taking and barriers faced by residents


Department of Psychiatry, Seth GSMC and KEM Hospital, Parel, Mumbai, Maharashtra, India

Date of Web Publication30-Nov-2018

Correspondence Address:
Rashmi V Singh
1212, Boys Wing, UGPG Hostel, KEM Hospital, Parel, Mumbai - 400 012, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aip.aip_42_18

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  Abstract 


It is a well-established fact that sexual health has a very strong influence on emotional as well as physical well-being. Hence, it is imperative that effort is taken to acquire information about sex-related issues in patients' lives. Substantial amount of literature is available stating the importance of a good sexual history. Negligence on the part of residents by avoiding adequate sexual history can lead to important problems going untouched. This article aims to give some insights into what exactly are the obstacles faced by residents in taking a good sexual history. It will help the residents to develop an unbiased attitude and be more facilitating while taking sexual history. This can go a long way to make the patients feel more encouraged and comfortable in sharing not only their sexual complaints but also their attitudes and beliefs regarding sex.

Keywords: Attitude, obstacles, sex history


How to cite this article:
Singh RV. The art of sexual history taking and barriers faced by residents. Ann Indian Psychiatry 2018;2:160-2

How to cite this URL:
Singh RV. The art of sexual history taking and barriers faced by residents. Ann Indian Psychiatry [serial online] 2018 [cited 2018 Dec 16];2:160-2. Available from: http://www.anip.co.in/text.asp?2018/2/2/160/246539



The WHO defines sexual health as a state of physical, mental, and social well-being in relation to sexuality. It requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence.

Human sexuality by definition is the expression of sexual sensation and related intimacy between human beings. Sexual health is an important aspect of overall health affecting not only the sexual function but also the interpersonal relationships and psychiatric and physiological well-being of men and women.[1],[2] For medical residents to approach sexual health for their patients in a positive, knowledgeable, and respectful way, training in sexual history taking is required. However, training in sexual history taking is rarely encountered in routine curriculum.

An accurate history taking is the first step toward patient care. It is a valuable and great help to lead residents toward correct diagnosis. Likewise, taking time to complete a sexual history is well worth the effort. Sexual dysfunctions are common among people and hence are important to assess because patients may be reluctant to self-report. Reluctance to report sexual complaints leads to failure in treating patients suffering from sexual dysfunction which may lead to a significant impact on patient's satisfaction, self-esteem, self-confidence, and intimate relationship.

There is a dearth of literature about the identification and management of sexual dysfunctions in the Indian context. Sex education is also not carried out in most of our schools as also medical schools where the students are still reticent to ask questions related to sexual functioning. Hence, unless the doctor is comfortable talking about the same, many disorders may go undetected.

Significant obstacles exist between the residents' capacity to ask a question and the patient's capacity to respond. Residents are comfortable talking about all systems and questions are asked without anxiety or inhibition to patients. Similarly, the patient experiences little or no hesitancy in responding truthfully to these paths of inquiry. The same milieu does not generally exist with sexual history taking.[3]

Some of the common answers given by residents so as to why they fail to take adequate sex histories are as follows:

  • A feeling of awkwardness
  • Limitation on time in an overcrowded outpatient department (OPD)
  • Inability to form a rapport
  • Lack of privacy in OPD settings
  • Asking for sexual complaints is irrelevant as it is not connected to patient's chief complaint
  • Not confident as to what to do with answers and what the next question should be
  • Inadequate training and education in sexual health at undergraduate level
  • Worry that patient may feel offended
  • What would the patient think about them?
  • What if questions were considered as misconduct?



  Why is Inquiry about Sexual Health is Important? Top


  • Not many people know that sexual dysfunctions are quite common. The estimated prevalence in the general population is quite high
  • In addition, medications such as antidepressants, diuretics, certain antihypertensives, and antipsychotics are known to cause sexual dysfunctions
  • Mortality and morbidity rates of sexually transmitted infections (STIs) including HIV/AIDS are quite significant
  • A sexual problem may present as a consequence of major disorders such as diabetes, cardiovascular disorder, and depression
  • Studies have shown that the frequency and enjoyment of sexual intercourse are significant predictors of longevity
  • Sometimes, sexual problems have a history of sexual abuse in the past.


Who should be asked about sexual problems?

Due to our overcrowded outpatient care, the patient might never come up with his/her sexual concern. It is the duty of the resident to ask questions regarding sexual health practices and preferences to every patient. It is only then that the patient will understand that it is a part of routine history taking. However, in emergency settings, one can withhold these questions till the acute condition is resolved completely. Sexual history taking can be carried out at all primary health-care centers.

When during history taking should the questions be asked?

  • In cases where chief complaint of patient is a sexual concern, then as a treating physician, one should give it the first priority
  • Otherwise, after taking the history of presenting complaint, you can further ask questions related to sexual health and practices during personal and social history taking
  • Ask open-ended questions. Some patients may find it difficult to initiate discussion
  • One can even ask specifically to patients, ”If you are comfortable, then I want to ask few questions related to your sexual health and practices”
  • Assure patient that it is a part of routine history taking
  • Physician can ask leading questions related to STI symptoms (discharge/itching/redness/lesions/pain during intercourse/burning micturition)
  • Once this is answered, residents can lead the history taking toward other sexual concerns.


How to take sexual history?

There are some basic principles that need to be followed for taking adequate sexual history which are as follows:

  • Be a good listener
  • Assure patient's confidentiality
  • Get to know the patient as a person (e.g., partners, children, jobs, and living circumstances)
  • Patients will never discuss their sexual complaints unless they are comfortable with their treating physician. Hence, developing a rapport with one's patient is the pillar of sexual history taking
  • Be gender neutral all the time
  • It is important to use simple language for one's patient to understand. As far as possible, use words in patient's vernacular language. If you do not know 1–2 words, do not hesitate to ask the patient
  • Make no assumptions about anything
  • One can use charts, pictures, pen, and paper to explain about minutest detail
  • Don't be critical or judgmental at any point of time
  • One should know where to stop. Note one's reactions
  • Involve partners if necessary, after discussing with the patient
  • If patient is not ready or is uncomfortable to continue the discussion, cut down the discussion further. Give a try on the next visit if patient is comfortable
  • The period of time covered within a patient's ”history” is not definitive, but a general rule of thumb is to ask about the past 12 months. It is important to ask about patient's gender expression, gender identity, sexual orientation, and preferences. It is important not to assume heterosexuality when obtaining a sexual history. Elicit information about sexual behavior and types of sexual practice as a part of assessment
  • There are five areas that one need to discuss with the patient thoroughly which can be given by 5Ps: partners, practices, protection from STDs, past history of STDs, and details of pregnancy
  • In special situation or circumstances, one needs to ask some additional questions
  • Also ask about past history of sexual abuse
  • In primary care, assure patients that all adults are asked these questions, regardless of age or marital status; emphasize confidentiality
  • Sometimes, simply inquiring about sexual practices of patients helps identify their sexual problems and how to proceed may be beneficial
  • Start the next session with a revision of the last one. Listen to patients' myths carefully. The patient should feel that the physician is interested
  • Try to counsel and psychoeducate them about their myths and misconceptions. The approach to such problems should include involvement of partners if possible
  • In difficult situations, one should also know to which specialty such patients should be referred.


Sexual history taking should be made a part of regular curriculum at undergraduate level. At postgraduate level, lectures, continual medical education, and workshops can be conducted to help improve their skills.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Nusbaum MR, Hamilton CD. The proactive sexual health history. Am Fam Physician 2002;66:1705-12.  Back to cited text no. 1
    
2.
World Health Organization. Defining Sexual Health: Report of a Technical Consultation on Sexual Health. Report of a WHO Meeting. Geneva, Switzerland: WHO; 2002. p. 28-31.  Back to cited text no. 2
    
3.
Green R, editor. Taking a sexual history. In: Human Sexuality: A Health Practitioner's Text. 2nd ed. Baltimore and London: Williams and Wilkins; 1979. p. 22-30.  Back to cited text no. 3
    




 

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